Return to Case List with Diagnoses or Case List as Unknowns

RESPIRATORY DISTRESS
Authored By: Brandon Peters and Barry Siegel, Prof of Radiology.
Patient: 58 year old male
History: 57-year-old man with lymphoma.
Image Size:[small][as-submitted]

Multimedia: 206901_1_submitted.avi
PET maximum intensity projection (MIP) images

Fig. 2
Coronal fused PET/CT

Fig. 3
Coronal fused PET/CT

Fig. 4
Coronal fused PET/CT in bone algorithm

Fig. 5
PET, CT, and fused PET/CT images.

Fig. 6
PET, CT, and fused PET/CT images.

Fig. 7
PET, CT, and fused PET/CT images.
Image Size:[small][as-submitted]

Findings: PET/CT:  There is intense FDG uptake in the primary and secondary muscles of respiration, including the intercostal muscles, scalene muscles, sternocleidomastoid muscles, and diaphragm.  No increased uptake in the pectoral or abdominal muscles is seen. There is right upper lobe bronchiectasis with surrounding consolidation/"ground glass opacification", demonstrating mild diffuse FDG uptake.  Multiple noncalcified parenchymal nodular densities with moderately increased uptake have increased significantly in size since the previous CT. 

Diagnostic CT (one month earlier): There is right upper lobe bronchiectasis with surrounding "ground glass opacity".
Diagnosis: Increased respiratory muscle exertion due to respiratory distress, likely due to progressive infection or graft versus host disease.
General Discussion: This is a 57-year-old man with diffuse large B cell lymphoma treated with allogeneic stem cell transplant approximately 7 months before this study, after having relapsed following multiple regimens of chemotherapy.  The patient had been treated for aspergillosis and cytomegalovirus infection previously.  A previous bronchial biopsy was negative for graft versus host disease. 
References: Aydin A, Hickeson M, Yu JQ, Zhuang H, Alavi A.  Demonstration of excessive metabolic activity of thoracic and abdominal muscles on FDG-PET in patients with chronic obstructive pulmonary disease.  Clin Nucl Med. 2005; 30:159-64.

Groves A.  Extensive skeletal muscle uptake of F18-FDG:  relation to immunosuppresants?  J Nucl Med Tech 2004; 32:206-8.
Comments:
No comments posted.
Additional Details:

Case Number: 206901Owner(s): Brandon Peters and Barry Siegel, Prof of RadiologyLast Updated: 12-07-2011
Anatomy: Skeletal System   Pathology: Other
Modality: CT, PETAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: ptnm

Case has been viewed 40 times.
Certified by Barry Siegel on 06-13-2009

The reader is fully responsible for confirming the accuracy of this content.
Text and images may be copyrighted by the case author or institution.